SMART Medicare update

April 30, 2014 at 01:44 PM
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At the 2014 RIMS Annual Conference & Exhibition, one session reviewed the new SMART Act (Strengthening Medicare and Repaying Taxpayers Act) and how it changes traditional Medicare Secondary Compliance.

Roy A. Franco, chief legal officer with Franco Signor LLC, and Bary Dillard, manager of guest claims for Walt Disney World, spoke to attendees about what is now legally required and what to expect in future regulations and policy from the Centers for Medicare and Medicaid Services, and what parts of the new law have been fully implemented and what remains to be done.

Franco and Dillard commended MARC, AAJ, RIMS, DRI and FMI for their support of the SMART Act. Both warned, however, that regulation is required for certain aspects of the law. 

According to the speakers, Medicare compliance is composed of three parts:

  1. Past, or "reimbursement of conditional payments"
  2. Present, or "reporting"
  3. Future, or "Medicare set asides"

It is the third compliance aspect that the SMART Act could not address, according to Franco. 

Why? It would require a great deal of money from the U.S. government. "If it would take money from the government, it would have to make money somewhere," Franco said. "It doesn't."

Franco then addressed SMART Act key provisions, which include:

  • Sec. 201: New cp demand and appeal rights;
  • Sec. 202: Sets annual MSP threshold;
  • Sec. 203: Softens MMSEA penalties;
  • Sec. 204: Probits use of SSN and HICN (privacy); and
  • Sec. 205: Adds three-year statute of limitations.
Franco and Dillard also spoke of the proposed process for complying with the SMART Act. 
  • Beneficiary registers at MyMedicare.gov;
  • Parties notify BCRC 185 days before S/J/A;
  • BCRC has 65 days to process CP, but can add 30 days; and
  • Download not valid unless refreshed (before 12/31/2015) three days prior to S/J/A.
All well and good, but both speakers stressed the fact that the SMART Act is not completely without flaws. For instance, it does not address future medicals, Medicare Advantage and Part D, and streamlined data reporting.
 
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